Indiana Network for Patient Care: Pioneering the future of health information exchange to advance population health

INDIANAPOLIS -- A team including Regenstrief Institute and Indiana University research scientists has published an in-depth case study on the Indiana Network for Patient Care (INPC), revealing how this mature health information exchange (HIE) has transformed from a clinical and claims data repository supporting individual patient care into a powerful, statewide – and even regional – engine for advancing public health and population well-being.

Over the last two decades, U.S. health policy has expanded its focus beyond the care of individuals to managing health at the population level, propelled by the “Triple Aim”: better patient experiences, improved population health and reduced costs. The INPC, created by Regenstrief and operated by the Indiana Health Information Exchange (IHIE), stands as a frontrunner in demonstrating how robust HIEs can realize this vision.

By the end of its first decade in 2004, the INPC captured data for 3.5 million patients from just nine Indiana counties. Since then it has grown exponentially. By the end of 2023, it incorporated records for more than 20 million patients, more than 16 billion clinical data elements, and contributions from 123 hospitals, 19,000 practices and 54,500 providers spanning Indiana and spillover regions in southern Michigan, Illinois, Ohio and Kentucky. This makes the INPC one of the largest and most mature clinical data repositories in the United States, providing considerable depth and breadth as the basis for an HIE.

The INPC’s unique success, according to co-lead author Karmen S. Williams, DrPH, MBA, MSPH, M.A., an assistant professor, City University of New York and a post-doctoral fellow graduate of the Indiana Training Program in Public and Population Health Informatics at Regenstrief Institute and Indiana University, is built on a foundation of core HIE “building blocks.” These foundational elements – such as patient identity management, provider directories, standardized terminology services and longitudinal record-linkage – enable the INPC to seamlessly integrate and harness vast swaths of health data. These building blocks have laid the groundwork for the development of complex, higher-level functions critical to both clinical and public health domains.

“The Indiana Network for Patient Care (INPC) has been an invaluable resource in my work,” said Dr. Williams. “Its extensive and detailed data supports groundbreaking research, impactful public health efforts and better patient outcomes. The INPC’s growth from capturing clinical interactions to enabling population health strategies shows the transformative power of robust health information exchanges. As a researcher, I’ve relied on the INPC’s rich, timely data to uncover critical insights and drive meaningful improvements across Indiana and beyond.”

Co-lead author Saurabh Rahurkar, DrPH, DDS, assistant professor, The Ohio State University Department of Biomedical Informatics and a post-doctoral fellow graduate of the Indiana Training Program in Public and Population Health Informatics at Regenstrief Institute and Indiana University, added, “Health information exchanges (HIEs) are vital to the workings of modern healthcare, and the Indiana Network for Patient Care (INPC) stands as a leading example – enhancing data sharing, research and public health while serving as a national model of sustainability. Long before ‘real-world data’ gained recognition from agencies like the FDA (U.S. Food and Drug Administration), the INPC was quietly enabling it, with Regenstrief Institute building the infrastructure to transform complex, longitudinal records into meaningful insight. As an informatician and researcher, I rely heavily on real world data to drive rigorous studies that generate robust evidence such as using the INPC to uncover harmful prescribing practices, and with AI (artificial intelligence) now a transformative force in both healthcare and public health, this data has become an indispensable foundation for smarter, more responsive systems.”

The INPC plays a pivotal role in improving the timeliness and completeness of notifiable disease reporting. By automating electronic laboratory reporting to public health agencies, the INPC notifies officials of new infections, triggers investigation and contact tracing, and supports rapid outbreak responses. The exchange has also enabled population-level clinical alerts – such as automated notifications for multi-drug-resistant organisms – helping protect hospital patients and the broader community.

Shaun Grannis, M.D., M.S., vice president for data and analytics at Regenstrief and one of the original creators of the Public Health Emergency Surveillance System (PHESS), said, “INPC and PHESS exemplify the power of collaboration and reusable, data-driven infrastructure in public health. By connecting hospitals statewide and enabling real-time, rapid-response surveillance, PHESS – built on the foundation of the INPC – has become vital to Indiana’s ability to detect, respond to and study emerging health threats. This enduring system demonstrates how health information exchange is essential for timely, effective public health action and research.” Dr. Grannis also is a professor with the IU School of Medicine.

Recognizing the inefficiencies caused by fragmented data, INPC innovators developed Health Dart – a Fast Healthcare Interoperability Resources (FHIR)-based app that integrates HIE data directly into a provider’s electronic health record (EHR). Deployed in 16 IU Health emergency departments across Indiana, Health Dart streamlines data retrieval for seven common clinical complaints, reducing the average number of clicks for clinicians from 50 to just 6 and slashing search times from 3 minutes to 10 seconds. The result: improved data use and faster, better-informed care decisions.

“The Indiana Network for Patient Care has been pivotal in making tools such as Health Dart possible,” said Titus Schleyer, DMD, MBA, PhD, research scientist with Regenstrief Institute and a professor at the IU School of Medicine. “By providing comprehensive, real-time patient data from across care settings, HIEs enable clinicians to access the information they need within their workflow, improving efficiency and the quality of patient care. Integrating INPC data directly into the EHR through Health Dart is an example of how HIE infrastructure can transform clinical decision-making and support improved outcomes.”

Leveraging its unparalleled breadth, the INPC supports a growing range of curated disease registries, improving surveillance, research and funding opportunities. For example, by linking with state cancer and sickle cell registries, the INPC helped uncover previously unidentified patients, supporting targeted interventions and resource allocation. Specialized registries for stroke, traumatic brain injury, diabetes and sexually transmitted infections help researchers and policymakers monitor treatment, outcomes and disparities across populations.

“Linking disease registries to the Indiana Network for Patient Care provides an exceptional opportunity to enhance data completeness, improve patient tracking and support more robust research and surveillance,” said Brian Dixon, PhD, MPA, director, Regenstrief Center for Biomedical Informatics and a professor with the IU Indianapolis Fairbanks School for Public Health. “By connecting these diverse data sources, we can uncover previously unrecognized cases, reduce data fragmentation and ultimately deliver more informed, coordinated and effective public health action across populations.”

Recognizing that health data must follow patients wherever care occurs, the INPC has been instrumental in the Patient Centered Data Home (PCDH) initiative – an innovative, grassroots solution that lets HIEs across the U.S. securely share admission, discharge and transfer data. Piloted in partnership with HIEs in neighboring states, the PCDH approach exchanged 8.5 million key messages within its first year, bringing the goal of nationwide health information interoperability within sight.

In addition to clinical information, INPC serves as the foundation for multi-domain data commons – pools of health and social data that facilitate advanced research and policy. The Indiana Addiction Data Commons (IADC), for instance, combines health, demographic, criminal justice and environmental data to inform state strategies for battling substance use disorders.

During the COVID-19 pandemic, IHIE, Regenstrief and other innovators collaborated with local partners using the INPC to rapidly develop statewide dashboards for tracking hospitalizations, ICU admissions and deaths – pinpointing disparities and guiding resources to Indiana’s most affected populations. By February 2023, the resulting COVID-19 Research Data Commons (CoRDaCo) had amassed in-depth records for nearly 1.9 million patients.

INPC data are now critical for Indiana’s Accountable Care Organizations (ACOs), providing comprehensive patient histories and supporting quality measurement, care coordination and cost-saving initiatives. Automated alerts and daily data feeds enable everyone from care managers to hospitalists to avoid redundant tests, prevent medical errors and ensure patients receive guideline-recommended screening and care.

The evolution of the INPC has wide-reaching implications for policymakers, clinicians and communities nationwide:

• Policy alignment: The INPC model aligns with U.S. policy shifts toward a national HIE structure, showing how state-level networks can bridge to regional and national data sharing.
• Overcoming barriers: Continued investment, standardization and a willingness to treat data as a shared public asset (rather than a proprietary resource) are key challenges ahead. Many regions lack population-scale HIEs and must prioritize building these essential platforms.
• Analytics and artificial intelligence (AI): As AI and predictive analytics become fundamental to healthcare, HIEs like INPC will be crucial for providing the large, inclusive datasets needed to ensure accurate, unbiased decision support tools.
• Supporting health-related social needs: By integrating non-clinical and community data, HIEs can shift healthcare from “sick care” toward true health promotion and disease prevention.

The authors conclude that HIEs are indispensable for the future of healthcare, public health and research. To fully realize their potential, HIEs must continue to innovate – expanding from point-of-care support to population health management, integrating clinical with non-clinical data and delivering measurable value to all stakeholders.

The INPC stands as an example for other states and regions seeking to modernize their health data infrastructures – and underscores the transformative power of coordinated, data-driven health systems in improving the lives of millions.

The paper, “Evolution of clinical Health Information Exchanges to population health resources: a case study of the Indiana network for patient care,” is published in the peer-reviewed journal BMC Medical Informatics and Decision Making.

Authors and affiliations, as listed in the publication
Karmen S. Williams¹, Saurabh Rahurkar^2,3, Shaun J. Grannis^3,4, Titus K. Schleyer^3,4 and Brian E. Dixon^3,5.

• ¹Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
• ²Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
• ³Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
• ⁴Indiana University School of Medicine, Indianapolis, IN, USA
• ⁵Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA

Funding and support

In addition to the organizations in the author list, the study was supported by effort from the Regenstrief Data Services, the Indiana Health Information Exchange and the Indiana Biosciences Research Institute.

Funding was provided, in part, by the Indiana Spinal Cord and Brain Injury Research Fund from the Indiana State Department of Health. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Indiana State Department of Health.

Dr. Williams was supported by a training grant (Award Number T15LM012502) from the National Library of Medicine of the National Institutes of Health. Dr. Dixon and Saurabh Rahurkar are supported by grant number R21HS025502 from the Agency for Healthcare Research and Quality (AHRQ). Part of this publication was made possible by the Lilly Endowment, Inc., Physician Scientist Initiative and the Indiana Clinical and Translational Sciences Institute (funded in part by grant ULI TR002529) from the Clinical and Translational Science.

Brian E. Dixon, PhD, MPA
In addition to his role as the director of public health informatics at the Regenstrief Institute and Indiana University Indianapolis Richard M. Fairbanks School of Public Health, Brian E. Dixon, PhD, MPA, is the director and a research scientist with the Clem McDonald Center for Biomedical Informatics at the Regenstrief Institute and a professor of health management and policy at the Fairbanks School. He is also an affiliate scientist at the U.S. Department of Veterans Affairs Health Systems Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center.

Titus K. Schleyer, DMD, MBA, PhD
In addition to his role as a research scientist with the Clem McDonald Center for Biomedical Informatics at Regenstrief Institute, Titus K. Schleyer, DMD, MBA, PhD, is the program director for learning health informatics at Regenstrief Institute and is a professor of biomedical informatics and a professor of medicine at Indiana University School of Medicine.

Shaun Grannis, M.D., M.S.
Dr. Shaun Grannis is vice president of data and analytics at Regenstrief Institute, the Regenstrief Chair in Medical Informatics, and a professor of family medicine at the Indiana University School of Medicine.